And finally ...
Withdrawal from temazepam (Restoril) 30mg
nightly with diazepam substitution. (30mg temazepam is
approximately equivalent to 15mg diazepam)
Night time
Equivalent diazepam dosage
Starting dosage temazepam 30mg
15mg
Stage 1 (1-2 weeks) temazepam 15mg
diazepam 7.5mg
15mg
Stage 2 (1-2 weeks) temazepam 7.5mg
diazepam 12mg
15.75mg
Stage 3 (1-2 weeks) Stop temazepam
diazepam 15mg
15mg
Stage 4 (1-2 weeks) diazepam 14mg
14mg
Stage 5 (1-2 weeks) diazepam 13mg
13mg
Stage 6 (1-2 weeks) diazepam 12mg
12mg
Stage 7 (1-2 weeks) diazepam 11mg
11mg
Stage 8 (1-2 weeks) diazepam 10mg
10mg
Stage 9 (1-2 weeks) diazepam 9mg
9mg
Stage 10 (1-2 weeks) diazepam 8mg
8mg
Stage 11 (1-2 weeks) diazepam 7mg
7mg
Stage 12 (1-2 weeks) diazepam 6mg
6mg
Stage 13 (1-2 weeks) diazepam 5mg
5mg
Stage 14 (1-2 weeks) diazepam 4mg
4mg
Stage 15 (1-2 weeks) diazepam 3mg
3mg
Stage 16 (1-2 weeks) diazepam 2mg
2mg
Stage 17 (1-2 weeks) diazepam 1mg
1mg
Stage 18 Stop diazepam
--
Schedule 10. Withdrawal from oxazepam (Serax) 20mg three times
daily (60mg) with diazepam (Valium) substitution (20mg
oxazepam is approximately equivalent to 10mg diazepam)
Morning
Midday
Evening/Night
Daily Diazepam
Equivalent
Starting dosage oxazepam 20mg oxazepam 20mg oxazepam 20mg
30mg
Stage 1
(1 week) oxazepam 20mg oxazepam 20mg oxazepam 10mg
diazepam 5mg
30mg
Stage 2
(1 week) oxazepam 10mg
diazepam 5mg oxazepam 20mg oxazepam 10mg
diazepam 5mg
30mg
Stage 3
(1 week) oxazepam 10mg
diazepam 5mg oxazepam 10mg
diazepam 5mg oxazepam 10mg
diazepam 5mg
30mg
Stage 4
(1-2 weeks) oxazepam 10mg
diazepam 5mg oxazepam 10mg
diazepam 5mg Stop oxazepam
diazepam 8mg
28mg
Stage 5
(1-2 weeks) Stop oxazepam
diazepam 8mg oxazepam 10mg
diazepam 5mg diazepam 8mg
26mg
Stage 6
(1-2 weeks) diazepam 8mg Stop oxazepam
diazepam 8mg diazepam 8mg
24mg
Stage 7
(1-2 weeks) diazepam 10mg diazepam 2mg diazepam 10mg
22mg
Stage 8
(1-2 weeks) diazepam 10mg Stop diazepam diazepam 10mg
20mg
Stage 9
(1-2 weeks) diazepam 8mg
--
diazepam 10mg
18mg
Continue as on Schedule 2 from Stage 12
Schedule 10 Notes:
Oxazepam is short-acting (half-life 4-15 hrs) so substitution to diazepam (long-acting) is recommended.
Diazepam need only be taken twice a day.
A change from 5mg to 2mg diazepam tablets is necessary from Stage 4 onwards.
Schedule 11. Withdrawal from chlordiazepoxide (Librium) 25mg
three times daily (75mg). (25mg chlordiazepoxide
is approximately equivalent to 10mg diazepam)
Morning
Midday
Evening/Night
Starting dosage chlordiazepoxide 25mg chlordiazepoxide 25mg chlordiazepoxide 25mg
Stage 1
(1-2 weeks) chlordiazepoxide 25mg chlordiazepoxide 20mg chlordiazepoxide 25mg
Stage 2
(1-2 weeks) chlordiazepoxide 20mg chlordiazepoxide 20mg chlordiazepoxide 25mg
Stage 3
(1-2 weeks) chlordiazepoxide 20mg chlordiazepoxide 20mg chlordiazepoxide 20mg
Stage 4
(1-2 weeks) chlordiazepoxide 25mg chlordiazepoxide 5mg chlordiazepoxide 25mg
Stage 5
(1-2 weeks) chlordiazepoxide 25mg Stop chlordiazepoxide chlordiazepoxide 25mg
Stage 6
(1-2 weeks) chlordiazepoxide 20mg
--
chlordiazepoxide 25mg
Stage 7
(1-2 weeks) chlordiazepoxide 20mg
--
chlordiazepoxide 20mg
Stage 8
(1-2 weeks) chlordiazepoxide 15mg
--
chlordiazepoxide 20mg
Stage 9
(1-2 weeks) chlordiazepoxide 15mg
--
chlordiazepoxide 15mg
Stage 10
(1-2 weeks) chlordiazepoxide 10mg
--
chlordiazepoxide 15mg
Stage 11
(1-2 weeks) chlordiazepoxide 10mg
--
chlordiazepoxide 10mg
Stage 12
(1-2 weeks) chlordiazepoxide 5mg
--
chlordiazepoxide 10mg
Stage 13
(1-2 weeks) chlordiazepoxide 5mg
--
chlordiazepoxide 5mg
Stage 14
(1-2 weeks) chlordiazepoxide
2.5mg (½ tablet)
--
chlordiazepoxide 5mg
Stage 15
(1-2 weeks) chlordiazepoxide
2.5mg (½ tablet)
--
chlordiazepoxide
2.5mg (½ tablet)
Stage 16
(1-2 weeks) Stop chlordiazepoxide
--
chlordiazepoxide
2.5mg (½ tablet)
Stage 17
--
--
Stop chlordiazepoxide
Schedule 11 Notes:
Chlordiazepoxide is long-acting so there is no need to take it more frequently than twice a day (hence Stages 4 and 5).
Because chlordiazepoxide is long-acting, there is no need for diazepam substitution.
If you are taking chlordiazepoxide capsules, change to tablets which can be halved for stages 14 onwards.
Schedule 12. Withdrawal from zopiclone (Zimovane) 15mg
with diazepam (Valium) substitution. (15mg zopiclone
is approximately equivalent to 10mg diazepam)
Night time
Daily Diazepam
Equivalent
Starting dosage zopiclone 15mg
10mg
Stage 1
(1 week) zopiclone 7.5mg
diazepam 5mg
10mg
Stage 2
(1 week) Stop zopiclone
diazepam 10mg
10mg
Stage 3 (1-2 weeks) diazepam 9mg
9mg
Stage 4 (1-2 weeks) diazepam 8mg
8mg
Then continue reducing diazepam by 1mg every 1-2 weeks as on Schedule 2
Schedule 12 Notes:
It is possible to withdraw directly from zopiclone using the smallest available tablets (3.75mg), but this dose of zopiclone is equivalent to 2.5mg diazepam making for rather abrupt dosage reductions.
This method can also be used for withdrawing from loprazolam and lormetazepam. 1mg of each of these is approximately equivalent to 10mg diazepam; their half-lives are 6-12 and 10-12 hrs respectively.
Schedule 13. Antidepressant Withdrawal Table
Drugs
Dosage strengths and formulations*
Tricyclics
amitriptyline (Tryptizol, Elavil) tabs 10, 25, 50mg; liquid 25mg/5ml
amoxapine (Asendis) tabs 25, 50, 100mg
clomipramine (Anafranil) caps 10, 25, 50mg; syrup 25mg/5ml
dothiepin (Prothiaden) tabs 25, 75mg
doxepin (Sinequan) caps 10, 25, 50, 75mg
imipramine (Tofranil) tabs 10, 25mg syrup 25mg/5ml
lofepramine (Gamanil) tabs 70mg; liquid 70mg/5ml
nortriptyline (Allegron, Pamelor) tabs 10, 25mg
protriptyline (Concordin, Vivactil) tabs 5, 10mg
trimipramine (Surmontil) tabs 10, 25mg
Related antidepressants
maprotiline (Ludiomil) tabs 10, 25, 50, 75mg
mianserin (Bolvidon, Norval) tabs 10, 30mg
trazodone (Molipaxin, Desyrel) caps 50, 100mg; tabs 150mg; liquid 50mg/5ml
viloxazine (Vivalan) tabs 50mg
MAOIs (monoamine oxidase inhibitors)
phenelzine (Nardil) tabs 15mg
moclobemide (Mannerix) tabs 150mg
tranylcypromine (Parnate) tabs 10mg
SSRIs (selective serotonin reuptake inhibitors)
citalopram (Cipramil, Celexa) tabs 10, 20, 40mg; liquid 40mg/ml (drops)
fluoxetine (Prozac) caps 20, 60mg; liquid 20mg/5ml
fluvoxamine (Faverin, Luvox) tabs(s) 50, 100mg
paroxetine (Seroxat, Paxil) tabs(s) 20, 30mg; liquid 20mg/5ml
sertraline (Lustral, Zoloft) tabs 50, 100mg
escitalopram (Cipralex, Lexapro) tabs 5, 10(s), 20mg(s)
Others
mirtazapine (Zispin, Remeron) tabs(s) 30mg
nefazodone (Dutonin, Serzone) tabs(s) 100, 200mg
reboxetine (Edronax, Vestra) tabs(s) 4mg
venlafaxine (Efexor, Effexor) tabs 37.5, 75mg
* tabs: tablets, (s) scored; caps: capsules; 5ml = 1 teaspoon
Schedule 13 Notes:
Guidelines for benzodiazepine users who are also taking an antidepressant and wish to withdraw from both drugs
Complete the benzodiazepine withdrawal before starting to taper the antidepressant.
Allow at least 4 weeks after stopping benzodiazepines before starting on antidepressant withdrawal.
Consult your doctor before starting to withdraw the antidepressant and agree on a tapering schedule.
Antidepressant withdrawal must be gradual to avoid withdrawal effects.
Make each dose reduction as small as possible, e.g. by halving the tablets or using a liquid preparation.
If smaller doses are not available, reduce by taking a tablet every other day, then every third day, etc.
Allow 1-2 weeks between each dosage reduction.
If withdrawal symptoms are severe (Chapter 3, Table 2) increase the dosage slightly (e.g. to the dose at your last reduction). When symptoms have settled, resume withdrawal at a slower rate.
With slow tapering, as outlined above, withdrawal symptoms from antidepressants are usually absent, or if they occur, are mild and short-lived.
